8/12/2019 The Psychological Consequences of False-Positive Screening Mammograms in the UK: A Systematic Review

1/1

BACKGROUND METHODS

RESULTS: Psychological Consequences Questionnaire

CONCLUSIONS

This project was fundedby the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 09/145/01) and will be publishedin full in Health

Technology Assessment. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health

Mary Bond1, Toby Pavey1, Karen Welch2, Chris Cooper1, Ruth Garside1, Sarah Dean1, Chris Hyde1

sity of Exeter, 2: Karen Welch Information Consultancy

Screening introduced in 1988

Women aged 47-73 invited every 3 years

1.73 million screened in 2010/11 England

65,000 (4%) recalled

13,100 (20%) cancer diagnoses

52,700 false-positives (80% recalls & 3% screened)

The Psychological Consequences of False-Positive Screening

Mammograms in the UK: A Systematic Review

Systematic review

False-positive vs. normal mammograms

All controlled studies & qualitative research

At least one month from all clear

Comprehensive electronic database, internet and

reference & citation searches

Psychological & qualitative outcomes

Dual independent screening

Critical appraisal

Narrative synthesis

4,423 Titles & abstracts after deduplication

95 Paper retrieved

10 Primary studies included (17 papers) 1 RCT

9 Observational

0 Published qualitative studies

0 Studies of ethnic or socio-economic groups

SEARCH RESULTS

.

.

.

.

Further_mammography

Ong et al. T1

Brett et al. T1

Brett et al. T2

Brett & Austoker T1

Brett & Austoker T3

FNA

Ong et al. T1

Brett et al. T1

Brett et al. T2

Brett & Austoker T1

Brett & Austoker T3

Biopsy

Ong et al. T1

Brett et al. T1

Brett et al. T2

Brett & Austoker T1

Brett & Austoker T3

Early_recall

Ong et al. T1

Brett et al. T1

Brett et al. T2

Brett & Austoker T1

Brett & Austoker T3

ID

Study

1.71 (1.24, 2.35)

3.29 (1.73, 6.23)

4.69 (1.93, 11.38)

1.92 (1.31, 2.83)

1.28 (0.82, 2.00)

1.97 (1.44, 2.69)

3.66 (1.94, 6.93)

4.57 (1.85, 11.26)

2.08 (1.40, 3.09)

1.80 (1.17, 2.77)

2.96 (2.19, 4.01)

5.28 (2.87, 9.68)

6.33 (2.59, 15.50)

2.72 (1.77, 4.17)

2.07 (1.22, 3.52)

2.13 (1.58, 2.87)

4.02 (2.15, 7.50)

6.10 (2.56, 14.54)

2.36 (1.64, 3.40)

1.82 (1.22, 2.72)

RR (95% CI)

1.71 (1.24, 2.35)

3.29 (1.73, 6.23)

4.69 (1.93, 11.38)

1.92 (1.31, 2.83)

1.28 (0.82, 2.00)

1.97 (1.44, 2.69)

3.66 (1.94, 6.93)

4.57 (1.85, 11.26)

2.08 (1.40, 3.09)

1.80 (1.17, 2.77)

2.96 (2.19, 4.01)

5.28 (2.87, 9.68)

6.33 (2.59, 15.50)

2.72 (1.77, 4.17)

2.07 (1.22, 3.52)

2.13 (1.58, 2.87)

4.02 (2.15, 7.50)

6.10 (2.56, 14.54)

2.36 (1.64, 3.40)

1.82 (1.22, 2.72)

RR (95% CI)

1.8 1 2 4 8 12

RESULTS: HADS & GHQ-28

.

.

Bull & Campbell: 6 weeks after assessment

HADS depression = borderline

HADS depression = abnormal

HADS anxiety = borderline

HADS anxiety = abnormal

Ellman et al.: 3 months after screening

GHQ-28 sub-clinical/mild

GHQ-28 mild/moderate

ID

Study

1.71 (0.77, 3.78)

2.61 (0.60, 11.44)

1.16 (0.58, 2.30)

1.46 (0.31, 6.90)

0.82 (0.49, 1.36)

1.19 (0.70, 2.00)

RR (95% CI)

1.71 (0.77, 3.78)

2.61 (0.60, 11.44)

1.16 (0.58, 2.30)

1.46 (0.31, 6.90)

0.82 (0.49, 1.36)

1.19 (0.70, 2.00)

RR (95% CI)

1.3 1 3 6 11

RESULTS: Going next time

McCann et al

O'Sullivan et al.

Brett and Austoker

Orton et al.

ID

Study

0.97 (0.96, 0.98)

0.99 (0.91, 1.08)

0.92 (0.86, 0.98)

1.03 (0.95, 1.13)

RR (95% CI)

0.97 (0.96, 0.98)

0.99 (0.91, 1.08)

0.92 (0.86, 0.98)

1.03 (0.95, 1.13)

RR (95% CI)

1.86 .92 1 1.08 1.13

False-positive mammograms can cause breast cancerspecific distress for up to three years

Distress may be related to the assessment process

General anxiety and depression are less likely

Women with a FPM are 2% - 4% less likely to attend

their next round of screeningContact: M.bond@exeter.ac.uk

1 month after the all clear, T2: 5 months after the all clear, T3: 35 months after the all clear